Abstract
IntroductionTo assess changes in renal blood flow (RBF) in human and experimental sepsis, and to identify determinants of RBF.MethodUsing specific search terms we systematically interrogated two electronic reference libraries to identify experimental and human studies of sepsis and septic acute renal failure in which RBF was measured. In the retrieved studies, we assessed the influence of various factors on RBF during sepsis using statistical methods.ResultsWe found no human studies in which RBF was measured with suitably accurate direct methods. Where it was measured in humans with sepsis, however, RBF was increased compared with normal. Of the 159 animal studies identified, 99 reported decreased RBF and 60 reported unchanged or increased RBF. The size of animal, technique of measurement, duration of measurement, method of induction of sepsis, and fluid administration had no effect on RBF. In contrast, on univariate analysis, state of consciousness of animals (P = 0.005), recovery after surgery (P < 0.001), haemodynamic pattern (hypodynamic or hyperdynamic state; P < 0.001) and cardiac output (P < 0.001) influenced RBF. However, multivariate analysis showed that only cardiac output remained an independent determinant of RBF (P < 0.001).ConclusionThe impact of sepsis on RBF in humans is unknown. In experimental sepsis, RBF was reported to be decreased in two-thirds of studies (62 %) and unchanged or increased in one-third (38%). On univariate analysis, several factors not directly related to sepsis appear to influence RBF. However, multivariate analysis suggests that cardiac output has a dominant effect on RBF during sepsis, such that, in the presence of a decreased cardiac output, RBF is typically decreased, whereas in the presence of a preserved or increased cardiac output RBF is typically maintained or increased.
Highlights
To assess changes in renal blood flow (RBF) in human and experimental sepsis, and to identify determinants of RBF
Multivariate analysis suggests that cardiac output has a dominant effect on RBF during sepsis, such that, in the presence of a decreased cardiac output, RBF is typically decreased, whereas in the presence of a preserved or increased cardiac output RBF is typically maintained or increased
Human studies We found only three studies conducted in septic intensive care unit (ICU) patients in which RBF was measured [17-19]
Summary
To assess changes in renal blood flow (RBF) in human and experimental sepsis, and to identify determinants of RBF. Acute renal failure (ARF) affects 5–7% of all hospitalized patients [1-3]. In particular, septic shock are important risk factors for ARF in wards and remain the most important triggers for ARF in the intensive care unit (ICU) [48]. The incidence of ARF is up to 51% [9] and that of severe ARF (i.e. ARF leading to the application of acute renal replacement therapy) is 5% [7,10]. The mortality rate associated with severe ARF in the ICU setting remains high [2-5,11]. A possible explanation for the high incidence and poor outcome of septic ARF relates to the lack of specific therapies. A decrease in renal blood flow (RBF), causing renal ischaemia, has been proposed as central to the pathogenesis of septic ARF [12-14]. The bulk of knowledge about RBF in sepsis is derived from animal studies
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